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Wang W, Duan J. Rectus sheath hematoma combined with COVID-19: A case report. World J Clin Cases 2024; 12:4325-4330. [PMID: 39015905 PMCID: PMC11235532 DOI: 10.12998/wjcc.v12.i20.4325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/25/2024] [Accepted: 05/22/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Rectus sheath hematoma (RSH) is uncommon, and because people have limited knowledge about it, it is difficult to recognize the symptoms in time, often de-laying optimal treatment. CASE SUMMARY Herein, we report a case of a 77-year-old female with RSH. The patient was treated at our hospital for coronavirus disease 2019. Anticoagulant treatment was administered during this period because of thrombosis. On the 8th d of treatment, the patient complained of abdominal pain. Ultrasonography revealed a solid cystic mass in the pelvic cavity. An emergency laparotomy was performed, and a huge hematoma was found in the deep layer of the rectus abdominis muscle. We used anticoagulants with caution based on the patient's condition. CONCLUSION Optimal management of patients with RSH s depends on timely diagnosis and when to reintroduce anticoagulants.
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Affiliation(s)
- Wei Wang
- Department of Obstetrics & Gynecology, Wuhan University of Science and Technology, Wuhan 430070, Hubei Province, China
| | - Jie Duan
- Department of Obstetrics & Gynecology, Hubei Maternal and Child Health Hospital, Wuhan 430070, Hubei Province, China
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2
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Cacioppa LM, Floridi C, Cocozza MA, Bruno A, Modestino F, Martella C, Rosati M, Paccapelo A, Mosconi C, Candelari R. The prominent role of percutaneous transarterial embolization in the treatment of anterior abdominal wall hematomas: the results of three high volume tertiary referral centers. LA RADIOLOGIA MEDICA 2023; 128:1125-1137. [PMID: 37458907 PMCID: PMC10473986 DOI: 10.1007/s11547-023-01678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/29/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Percutaneous transarterial embolization (PTE) represents a fast, safe and effective option for life-threatening anterior abdominal wall hematomas (AWHs) and those unresponsive to conservative treatment. Our study aims to assess cumulative results of safety, technical and clinical success of PTE performed in three high-volume tertiary referral centers and to evaluate the efficacy of the different embolic materials employed. MATERIALS AND METHODS A consecutive series of 124 patients (72.8 ± 14.4 years) with AWHs of different etiology submitted to PTE were retrospectively collected and analyzed. Clinical success, defined as absence of recurrent bleeding within 96 h from PTE, was considered as primary endpoint. The results of the comparison of three groups based on embolic agent employed were also analyzed. RESULTS Spontaneous AWHs accounted for 62.1%, iatrogenic for 21.8% and post-traumatic for 16.1% of cases. SARS-CoV-19 infection was present in 22.6% of patients. The most commonly embolized vessels were epigastric inferior artery (n = 127) and superior epigastric artery (n = 25). Technical and clinical success were 97.6 and 87.1%, respectively. Angiographic signs of active bleeding were detected in 85.5% of cases. Four (4%) major complications were reported. The comparison of the three groups of embolic agents (mechanical, particulate/fluid and combined) showed no statistically significant differences in terms of clinical success. SARS-CoV-2 infection was found to be an independent factor for recurrent bleeding and poor 30-day survival. CONCLUSION PTE performed with all the embolic agent employed in our centers is a safe and effective tool in the treatment of life-threatening anterior AWH of each origin.
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Affiliation(s)
- Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
| | - Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Antonio Bruno
- Diagnostic and Interventional Radiology Unit, Maggiore Hospital "C. A. Pizzardi", 40133, Bologna, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Claudia Martella
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Marzia Rosati
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Alexandro Paccapelo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
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3
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Emekli E, Yıldırım M, Türkkanı MH, Ödemiş Başpınar E. Rectus Sheath Hematoma as a Complication in Patients With COVID-19: Clinical and Imaging Findings. Cureus 2023; 15:e38943. [PMID: 37313085 PMCID: PMC10259751 DOI: 10.7759/cureus.38943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Objectives This study aims to investigate the frequency of rectus sheath hematoma (RSH), clinical findings, imaging findings, and prognosis in patients admitted to the hospital due to COVID-19. Methods In this retrospective study, the patient's demographic characteristics, known diseases, laboratory values, RSH-related symptoms, the treatment they received, imaging modality used to diagnose RSH, and side and size of RSH were recorded. In addition, the inpatient ward to which the patients were admitted, length of hospital stay, time from the beginning of anticoagulant use to the diagnosis of RSH, and prognosis were noted. Results A total of 9,876 patients were admitted to the hospital due to COVID-19 and started anticoagulant treatment. Of these patients, 12 (0.12%) were determined to have RSH (female/male ratio: 5). The prothrombin time, activated partial thromboplastin time, international normalized ratio, hemoglobin, and hematocrit values of 11 patients were within the reference ranges. The mean length of hospital stay was 12 (4.25-22.5) days, and the duration of anticoagulant use was 5.5 (4-10.75) days. RSH was diagnosed using USG in 10 patients and CT in two patients. Conclusion There has been an increase in the use of anticoagulants due to COVID-19, and accordingly, RSH is now more frequently diagnosed and has a more fatal course. Female gender, advanced age, severe COVID-19 disease, and elevated d-dimer at the time of presentation can be considered risk factors for the development of RSH. All physicians who treat and follow up on patients with COVID-19 should consider the possibility of RSH in the differential diagnosis of patients with acute abdominal pain and palpable masses. USG should be undertaken as the first-line imaging modality for the diagnosis of patients, but CT may also be necessary to detect RSH in some cases.
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Affiliation(s)
- Emre Emekli
- Radiology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, TUR
| | - Mesut Yıldırım
- Radiology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, TUR
| | | | - Emel Ödemiş Başpınar
- Infectious Diseases and Clinical Microbiology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, TUR
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4
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Senthilkumaran S, Almeida JR, Williams J, Salim A, Williams HF, Thirumalaikolundusubramanian P, Patel K, Vaiyapuri S. Russell's viper envenomation induces rectus sheath haematoma. Toxicon 2023; 224:107037. [PMID: 36690089 DOI: 10.1016/j.toxicon.2023.107037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/07/2023] [Accepted: 01/20/2023] [Indexed: 01/22/2023]
Abstract
Snakebite envenomation causes systemic and local manifestations, which result from the individual or synergistic actions of multiple venom components. The pathological hallmarks of medically important venomous snakes such as the Indian Russell's viper (Daboia russelii) are well known. Envenomation by Russell's viper is typically characterised by coagulopathies, muscular damage, nephrotoxicity, and neurotoxicity. However, recent reports have revealed several unusual complications that provide a better understanding of Russell's viper envenomation effects. To further strengthen this, here, we report a case of Russell's viper bite that induced acute abdominal pain, which was intensified on day two and conservatively treated under medical supervision. Both Fothergill and Carnett signs were positive for this patient. An ultrasound imaging revealed a dissimilar dense mass, and the abdominal computed tomography scan confirmed rectus sheath haematoma. The clinical management involved the administration of polyvalent antivenom, packed red blood cells, fresh frozen plasma, and platelets. The patient recovered gradually and was discharged from the hospital eight days after the bite. Overall, this case presentation shares an uncommon experience and adds new insights into the complex series of rare pathological events associated with Russell's viper bites in India. The scientific documentation of relatively infrequent entities based on an ongoing living assessment of medical experiences, for example, this rectus sheath haematoma, constitutes valuable guidance for an adequate diagnosis and timely treatment. Essential awareness among clinicians and further research on understanding the molecular relationship between Russell's viper venom and rectus sheath haematoma will improve patient outcomes and understanding of this condition, respectively.
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Affiliation(s)
| | - José R Almeida
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - Jarred Williams
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - Anika Salim
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - Harry F Williams
- Toxiven Biotech Private Limited, Coimbatore, 641042, Tamil Nadu, India
| | | | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, RG6 6UB, UK
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5
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Kirkan EF, Ulgur HS, Comert S, Erol C, Yildirak MK, Ozkan OF. Management of Spontaneous Major Rectus Sheath Hematoma in a COVID-19 Patient: A Case Report and Literature Review. Cureus 2022; 14:e29206. [PMID: 36258938 PMCID: PMC9569153 DOI: 10.7759/cureus.29206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
A rectus sheath hematoma, which is mostly encountered due to abdominal traumas or anticoagulant use, can be challenging, and a delayed diagnosis may lead to hypovolemic shock and even death. In this study, we aimed to present the management of a case of rectus sheath hematoma that developed in a patient who was hospitalized and under coronavirus disease 2019 (COVID-19) treatment. A 70-year-old female patient was admitted to the intensive care unit (ICU) due to respiratory failure and developed a sudden onset of tachycardia and hypotension. The patient was then diagnosed with a rectus sheath hematoma and after ensuring hemodynamic stability she was treated with angiographic embolization. Following the treatment, the patient remained hemodynamically stable and a control computed tomography (CT) revealed regression in the hematoma. Rectus sheath hematomas especially accompanied by additional comorbidities or aggressive surgical interventions may result in high mortality rates in the early period. It should also be kept in mind that during the COVID-19 pandemic, which has affected the world in the last two years, rectus sheath hematomas may be the underlying cause of sudden hypotension and abdominal distension, and it should not be forgotten that angiographic embolization performed by experienced interventional radiologists is the mainstay of treatment in cases where hemodynamic stability can’t be achieved.
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6
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Taguchi K, Kamei Y, Kusakabe E, Yamashita M, Noda H, Aoki R, Nishiyama K, Murakami A, Tanaka H, Matsuda M, Kido T, Sato N, Takada Y. Non-traumatic bilateral rectus sheath hematoma during septic disseminated intravascular coagulation. Radiol Case Rep 2022; 17:1737-1740. [PMID: 35360185 PMCID: PMC8960865 DOI: 10.1016/j.radcr.2022.02.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
A non-traumatic abdominal wall hematoma is rare, and occurs occasionally due to coughing, physical activity, or antithrombotic/anticoagulant therapy. The condition is usually unilateral; however, rare bilateral cases have been reported. Here, we report a rare case of a non-traumatic bilateral rectus sheath hematoma. The patient was a 60-year-old woman who was urgently admitted to our hospital due to the occurrence of pneumonia during postoperative chemotherapy for breast cancer. Because she exhibited disseminated intravascular coagulation, a therapy with antibacterial agents, thrombomodulin alpha, and catecholamines was initiated. During hospitalization, hemorrhagic shock due to hematomas in both rectus abdominis muscles was observed without any discernible cause. Subsequent emergency angioembolization was successful, and abdominal computed tomography performed 3 months after the onset of the rectus sheath hematoma confirmed a reduction in the hematoma size.
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7
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Di Pietro S, Tiralongo F, Desiderio CM, Vacirca F, Palmucci S, Giurazza F, Venturini M, Basile A. Efficacy of Percutaneous Transarterial Embolization in Patients with Spontaneous Abdominal Wall Hematoma and Comparison between Blind and Targeted Embolization Approaches. J Clin Med 2022; 11:jcm11051270. [PMID: 35268360 PMCID: PMC8911449 DOI: 10.3390/jcm11051270] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Endovascular treatment of abdominal wall hematomas (AWHs) has been increasingly used when conservative treatments were not sufficiently effective, and it is often preferred to surgical interventions. The aim of our study was to evaluate the safety and technical and clinical success of percutaneous transarterial treatment of AWH and to evaluate the efficacy of blind embolization compared to targeted embolization. Materials and Methods: We retrospectively enrolled 43 patients (23 men and 20 females) with spontaneous AWH who underwent digital subtraction angiography (DSA) and embolization, focusing on the presence of signs of bleeding at pre-procedural CT-Angiography (CTA) and at DSA. Furthermore, we divided patients into two groups depending on blind or targeted embolization approaches. Results: The mean age of the study population was 71 ± 12 years. CTA revealed signs of active bleeding in 31 patients (72%). DSA showed signs of active bleeding in 34 patients (79%). In nine patients (21%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 33 patients (77%), while 10 patients (23%) rebled within 96 h, and all of them were re-treated. No major peri-procedural complication was reported. The comparison between blind and targeted embolization showed no statistically significant differences for characteristics of groups and for clinical success rates (78% and 77%, respectively, −p = 0.71). The technical success was 100% in both groups. Conclusions: Our study confirms that transarterial embolization is a safe and effective option for the treatment of spontaneous AWHs, and it suggests that the efficacy and safety of blind embolization is comparable to non-blind.
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Affiliation(s)
- Stefano Di Pietro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
- Correspondence: ; Tel.: +39-393-2067-572
| | - Carla Maria Desiderio
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Vacirca
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy;
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
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8
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Dennison JJ, Carlson S, Faehling S, Phelan H, Tariq M, Mubarik A. Splenic infarction and spontaneous rectus sheath hematomas in COVID-19 patient. Radiol Case Rep 2021; 16:999-1004. [PMID: 33619439 PMCID: PMC7881734 DOI: 10.1016/j.radcr.2021.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022] Open
Abstract
Multiple studies and reports have suggested that coronavirus disease-19 (COVID-19) promotes arterial and venous thrombotic events in multiple organ systems, although the mechanism leading to a hypercoagulable state is still unknown. Few cases of splenic infarction associated with COVID-19 have been reported, of which half were found incidentally upon autopsy. This may be due to a clinically silent presentation or the symptoms being wrongfully attributed to pain caused by the effects of COVID-19. Due to the rarity of the condition and its lack of consistent symptomatology, splenic thromboembolism can be difficult to diagnose. Awareness of the condition and high clinical suspicion will help the clinician identify and manage the problem. Hemorrhage in patients with COVID-19 is uncommon in the hypercoagulable state that threatens thrombus formation in patients with COVID-19 infection. Despite prophylactic treatment with anticoagulation therapies, patients are more prone to developing clots. It is also well-known that therapeutic anticoagulation can place patients at a higher risk of bleeding. Thus, this unique population is at risk of developing both thrombotic and hemorrhagic events. We report a rare case of splenic infarction in a patient with confirmed COVID-19 infection despite prophylactic treatment with low-molecular-weight heparin which was found incidentally during workup for 2 other rare conditions: spontaneous rectus sheath hematoma and microhemorrhage or thrombus of the mesenteric vessels.
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Affiliation(s)
- Jennifer J Dennison
- Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI, 54401 USA
| | - Samuel Carlson
- Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI, 54401 USA
| | - Shannon Faehling
- Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI, 54401 USA
| | - Hannah Phelan
- Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI, 54401 USA
| | | | - Ateeq Mubarik
- Ascension Saint Michael's Hospital, Stevens Point, WI.,Clinical Assistant Professor, Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI 54401 USA
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9
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Mendes D, Penedones A, Martins M, Cavadas S, Alves C, Batel‐Marques F. Rectus sheath hematoma in patients receiving subcutaneous enoxaparin: A case series of five patients. Clin Case Rep 2020; 8:3432-3439. [PMID: 33363947 PMCID: PMC7752400 DOI: 10.1002/ccr3.3427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/23/2020] [Accepted: 10/03/2020] [Indexed: 11/10/2022] Open
Abstract
Physicians must acknowledge the potential risk of RSH with enoxaparin. Switching home anticoagulation by enoxaparin upon hospital admission is common, but it may put patients at higher risk for RSH. Management guidelines are needed in this setting.
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Affiliation(s)
- Diogo Mendes
- UFC – Coimbra Regional Pharmacovigilance UnitCHAD – Centre for Health Technology Assessment and Drug ResearchAIBILI – Association for Innovation and Biomedical Research on Light and ImageCoimbraPortugal
- DruSER.Net – Drug Safety and Effectiveness Research NetworkCoimbraPortugal
| | - Ana Penedones
- UFC – Coimbra Regional Pharmacovigilance UnitCHAD – Centre for Health Technology Assessment and Drug ResearchAIBILI – Association for Innovation and Biomedical Research on Light and ImageCoimbraPortugal
- DruSER.Net – Drug Safety and Effectiveness Research NetworkCoimbraPortugal
| | - Michele Martins
- DruSER.Net – Drug Safety and Effectiveness Research NetworkCoimbraPortugal
- CHBV – Centro Hospitalar do Baixo VougaAveiroPortugal
| | - Susana Cavadas
- DruSER.Net – Drug Safety and Effectiveness Research NetworkCoimbraPortugal
- CHBV – Centro Hospitalar do Baixo VougaAveiroPortugal
| | - Carlos Alves
- UFC – Coimbra Regional Pharmacovigilance UnitCHAD – Centre for Health Technology Assessment and Drug ResearchAIBILI – Association for Innovation and Biomedical Research on Light and ImageCoimbraPortugal
- DruSER.Net – Drug Safety and Effectiveness Research NetworkCoimbraPortugal
- Laboratory of Social Pharmacy and Public HealthSchool of PharmacyUniversity of CoimbraCoimbraPortugal
| | - Francisco Batel‐Marques
- UFC – Coimbra Regional Pharmacovigilance UnitCHAD – Centre for Health Technology Assessment and Drug ResearchAIBILI – Association for Innovation and Biomedical Research on Light and ImageCoimbraPortugal
- DruSER.Net – Drug Safety and Effectiveness Research NetworkCoimbraPortugal
- Laboratory of Social Pharmacy and Public HealthSchool of PharmacyUniversity of CoimbraCoimbraPortugal
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10
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Abstract
Background Rectus sheath hematoma (RSH) is an uncommon entity associated with predisposing factors such as anticoagulation. It may mimic more frequent abdominal conditions and its accurate diagnosis is important to focus on the correct treatments and improve morbidity and mortality. Case presentation An elderly patient with shock, abdominal pain, palpable abdominal mass, and anemia was suspected of having a large RSH by point-of-care ultrasound (POCUS), which was then confirmed by computed tomography. Surgery was performed, markedly improving his clinical status. Conclusions POCUS has a good sensitivity for the diagnosis of RSH and it is also an excellent tool for patient follow-up. Electronic supplementary material The online version of this article (10.1186/s13089-019-0129-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gabriela Bello
- Intensive Care Unit, Hospital Central de las Fuerzas Armadas (DNSFFAA), 3060, 8 de Octubre Ave., 11600, Montevideo, Uruguay
| | - Pablo Blanco
- Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., Necochea, 7630, Argentina.
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